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Patient has complaints of ocular itching and tearing
This month’s Corneal Health column looks at a woman with dry eye symptoms.
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Eric D. Donnenfeld, MD: A 56-year-old woman has a chief complaint of foreign body sensation, itching and tearing. She has seasonal allergies and is using an oral nonspecific antihistamine and preserved tears. How do you manage this patient who has basically just some trace conjunctival staining and no corneal staining? Schirmer’s scores are good at 9 and 8. There is a fairly normal tear meniscus, and she has mild allergies. Dr. Raizman, what would you do for a patient like this? You are our resident expert in allergies and dry eye.
 Eric D. Donnenfeld |
Michael B. Raizman, MD: Before I even think about the specific eye management, I look at the patient’s other medications. You mentioned the antihistamines. I think there is a common misconception that the newer generation oral antihistamines are better for the eyes than the older. I think all of the oral antihistamines have the potential to dry the eye. If possible, I like to get patients who have dry eye symptoms off of their oral antihistamines. Usually they are taking them more for their rhinitis than for their eyes, and there are a lot of good nasal sprays now. So I will get them off of the oral and put them on a nasal spray and a topical antihistamine for the eye. And that often helps the dryness considerably.
 Michael B. Raizman |
Dr. Donnenfeld: Just stopping the oral medication and moving them to more localized therapy can help. That is exactly what we did, and the patient responded extremely well.
What if the patient had ocular symptoms of allergy? Do modern topical antihistamines have a drying effect on the eye? And are there certain classes of agents that you might use in this patient?
Dr. Raizman: I believe that all of the topical antihistamines we have now are safe. I have never seen a patient develop dryness from the topical medications. I just do not believe that is true.
For more information:
- Eric D. Donnenfeld, MD, is a cornea specialist in private practice at Ophthalmic Consultants of Long Island and co-chairman of Cornea and External Disease at Manhattan Eye, Ear and Throat Hospital. He can be reached at Ryan Medical Arts Building, 2000 North Village Ave., Rockville Centre, NY 11570; 516-766-2519; fax: 516-766-3714; e-mail: eddoph@aol.com.
- Michael B. Raizman, MD, can be reached at New England Eye Center, Tufts University School of Medicine, 750 Washington St., Box 450, Boston, MA 02111; 617-636-4219; fax: 617-636-4866.